Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Department of Medical Oncology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
BMC Med Imaging. 2021 Apr 26;21(1):75. doi: 10.1186/s12880-021-00605-4.
Multiple guidelines for pancreatic ductal adenocarcinoma (PDAC) suggest that all stages of patients need to receive postoperative adjuvant chemotherapy. S-1 is a recently emerged oral antitumour agent recommended by the guidelines. However, which population would benefit from S-1 needs to be determined, and predictors of chemotherapy response are needed for personalized precision medicine. This pilot study aimed to initially identify whether whole-tumour evaluation with MRI and radiomics features could be used for predicting the efficacy of S-1 and to find potential predictors of the efficacy of S-1 as evidence to assist personalized precision treatment.
Forty-six patients with PDAC (31 in the primary cohort and 15 in the validation cohort) who underwent curative resection and subsequently adjuvant chemotherapy with S-1 were included. Pre-operative abdominal contrast-enhanced MRI was performed, and radiomics features of the whole PDAC were extracted from the primary cohort. After univariable analysis and radiomics features selection, a multivariable Cox regression model for survival analysis was subsequently used to select statistically significant factors associated with postoperative disease-free survival (DFS). Predictive capacities of the factors were tested on the validation cohort by using Kaplan-Meier method.
Multivariable Cox regression analysis identified the probability of TWI_NGTDM_Strength and tumour location as independent predictors of the efficacy of S-1 for adjuvant chemotherapy of PDAC (p = 0.005 and 0.013) in the primary cohort, with hazard ratios (HRs) of 0.289 and 0.293, respectively. Further survival analysis showed that patients in the low-TWI_NGTDM_Strength group had shorter DFS (median = 5.1 m) than those in the high-TWI_NGTDM_Strength group (median = 13.0 m) (p = 0.006), and patients with PDAC on the pancreatic head exhibited shorter DFS (median = 7.0 m) than patients with tumours in other locations (median = 20.0 m) (p = 0.016). In the validation cohort, the difference in DFS between patients with low-TWI_NGTDM_Strength and high-TWI_NGTDM_Strength and the difference between patients with PDAC on the pancreatic head and that in other locations were approved, with marginally significant (p = 0.073 and 0.050), respectively.
Whole-tumour radiomics feature of TWI_NGTDM_Strength and tumour location were potential predictors of the efficacy of S-1 and for the precision selection of S-1 as adjuvant chemotherapy regimen for PDAC.
多项胰腺导管腺癌（PDAC）指南建议所有阶段的患者均需接受术后辅助化疗。S-1 是一种新出现的口服抗肿瘤药物，被指南推荐。然而，需要确定哪些人群将从 S-1 中受益，并且需要预测化疗反应的生物标志物，以便为个性化精准医学提供依据。本研究旨在初步探讨全肿瘤 MRI 评估和放射组学特征是否可用于预测 S-1 的疗效，并寻找 S-1 疗效的潜在预测标志物，为辅助个性化精准治疗提供依据。
纳入 46 例接受根治性切除术且随后接受 S-1 辅助化疗的 PDAC 患者（原发性队列 31 例，验证性队列 15 例）。所有患者均接受腹部增强 MRI 检查，并从原发性队列中提取 PDAC 的全肿瘤放射组学特征。在单变量分析和放射组学特征选择后，使用多变量 Cox 回归模型进行生存分析，以选择与术后无病生存（DFS）相关的统计学显著因素。然后，使用 Kaplan-Meier 方法在验证性队列中测试这些因素的预测能力。
多变量 Cox 回归分析确定 TWI_NGTDM_Strength 概率和肿瘤位置是 PDAC 患者 S-1 辅助化疗疗效的独立预测因素（p=0.005 和 0.013），风险比（HR）分别为 0.289 和 0.293。进一步的生存分析显示，低 TWI_NGTDM_Strength 组患者的 DFS 更短（中位=5.1 个月），而高 TWI_NGTDM_Strength 组患者的 DFS 更长（中位=13.0 个月）（p=0.006），胰腺头部的 PDAC 患者的 DFS 更短（中位=7.0 个月），而其他部位的 PDAC 患者的 DFS 更长（中位=20.0 个月）（p=0.016）。在验证性队列中，低 TWI_NGTDM_Strength 组和高 TWI_NGTDM_Strength 组之间的 DFS 差异以及胰腺头部 PDAC 患者和其他部位 PDAC 患者之间的 DFS 差异得到了证实，分别为 marginally significant（p=0.073 和 0.050）。
全肿瘤 TWI_NGTDM_Strength 和肿瘤位置的放射组学特征是 S-1 疗效的潜在预测因素，可用于 PDAC 患者 S-1 辅助化疗方案的精准选择。
